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PubMed2000

Numerical simulation of ultrasound-thermotherapy combining nonlinear wave propagation with broadband soft-tissue absorption.

Ultrasound (US) thermotherapy is used to treat tumours, located deep in human tissue, by heat. It features by the application of high intensity focused ultrasound (HIFU), high local temperatures of about 90 degrees C and short treating time of a few seconds. Dosage of the therapy remains a problem. To get it under control, one has to know the heat source, i.e. the amount of absorbed US power, which shows nonlinear influences. Therefore, accurate simulations are essential. In this paper, an improved simulation model is introduced which enables accurate investigations of US thermotherapy. It combines nonlinear US propagation effects, which lead to generation of higher harmonics, with a broadband frequency-power law absorption typical for soft tissue. Only the combination of both provides a reliable calculation of the generated heat. Simulations show the influence of nonlinearities and broadband damping for different source signals on the absorbed US power density distribution.

Computer Simulation↗
PubMed1996

High-energy transurethral microwave thermotherapy: a thermoablative treatment for benign prostatic obstruction.

OBJECTIVES: High-energy transurethral microwave thermotherapy (TUMT) was developed to increase treatment efficacy over former low-energy treatment protocols as an outpatient-based, anesthesia-free procedure for patients with benign prostatic obstruction. A Phase II study was conducted to evaluate treatment outcome and to enlighten possible prognostic factors. METHODS: Eighty-five patients with lower urinary tract symptoms were included in the study. A Madsen symptom score of 8 or more, a maximum flow less than 15 mL/s, and a postvoid residual urine volume (PVR) of under 350 mL were the main requirements for entry. RESULTS: Eleven patients were lost to follow-up, making 74 patients evaluable at 1-year follow-up. Significant improvement was noticed in all indices: the Madsen symptom score improved 58% from baseline; the maximum flow rate improved from 9.4 to 14.9 mL/s, with a decrease in PVR of 80 mL to 25 mL; bladder outlet obstruction could be relieved in 78% of patients; and prostate volume decreased by 20%, with cavity formation in 42% of patients. Patients with bigger prostates (greater than 40 cm3) and patients with more severe bladder-outlet obstruction appeared to be the best responders. Post-treatment morbidity consisted of a prolonged need for transurethral catheter drainage (mean 16 days), with correlated irritative voiding complaints for an average of 2 to 3 weeks. CONCLUSIONS: Overall improvement of high-energy thermotherapy now shows comparable results to surgical resection of the prostate.

Aged↗
PubMed1998

Microwave thermotherapy for benign prostatic hyperplasia with the Dornier Urowave: results of a randomized, double-blind, multicenter, sham-controlled trial.

OBJECTIVES: To study the efficacy and safety of a new transurethral microwave thermotherapy device (the Urowave) in the treatment of men with clinical benign prostatic hyperplasia (BPH) in a randomized, double-blind, sham-controlled trial. METHODS: A total of 220 patients (mean age 66.2 years) with clinical BPH, an American Urological Association symptom index (AUA SI) of 13 points or more, and a peak flow rate of 12 mL/s or less were enrolled and randomized 2:1 for active versus sham treatment. All treatments were conducted as an outpatient procedure under local anesthesia, with oral sedation and analgesia only. Patients were followed up at 1 week and 1, 3, and 6 months after treatment. RESULTS: The treatments were well tolerated, and no patient received general or spinal anesthesia. The AUA SI dropped from 23.6 to 12.7 points at 6 months (P < 0.05) in the active group and from 23.9 to 18.0 points in the sham-treated group (P < 0.05, between-group difference). Statistically significant improvements were also noted for peak flow rate (7.7 to 10.7 mL/s at 6 months for active treatment, 8.1 to 9.8 mL/s for sham treatment, P < 0.05, between-group difference) and for average flow rate. A decrease in AUA SI of more than 30% was achieved in 72% versus 38% of patients (active versus sham treatment, respectively) and more than 50% in 50% versus 19% of patients. In general, active Urowave-treated patients perceived "a lot" of improvement, whereas sham-treated patients perceived "a little" to "some" improvement. More of the actively treated patients had dysuria and urgency after treatment, and ejaculatory dysfunction (e.g., hematospermia) was more common in actively treated patients as well. Secondary urinary retention after removal of the catheter occurred in 8 patients (5.4%). CONCLUSIONS: The Dornier Urowave transurethral microwave thermotherapy device for treatment of clinical BPH is effective in decreasing symptoms and bother and improving quality of life and flow rate and is superior to sham treatment. Patients perceive a great deal of improvement, independent of their baseline symptom severity. Adverse events are in general transient and mild in nature. Extended follow-up is necessary to document long-term durability of improvements.

Aged↗
PubMed2002

An experimental study on Nd-YAG laser induced thermotherapy. Its possible application of the laser irradiation for therapy of hepatocellular carcinoma.

It has been reported that the local thermotherapy is useful in treatment of hepatocelluar carcinoma complicated with severe liver cirrhosis (LC). We studied the effect of laser beam generated by a newly developed Nd-YAG laser system on liver tissue of piglet. The system was composed of their quartz bare fiber with a cone-shaped tip. After liver was exposed by incision of abdomen under general anesthesia, the fiber was inserted into liver tissue and then the laser beam was generated. The power, duration and frequency of irradiation were varied. The coagulated area was inspected measured and examined histologically. The system produced an oval-shaped coagulated area in front of the needle tip. Furthermore, the volume of tissue coagulated was correlated with the total output of laser, enabling us to estimate the coagulated volume based on the laser output applied. Our findings indicated that Nd-YAG laser-induced thermotherapy would be successfully applied for the clinical treatment of HCC.

Journal Article↗
PubMed2003

Transpupillary thermotherapy of predominantly occult choroidal neovascularization in age-related macular degeneration with 12 months follow-up.

PURPOSE: To perform a phase I/II safety and efficacy study in order to assess the outcome following transpupillary thermotherapy (TTT) for occult choroidal neovascularization (CNV) with no or minimally classic CNV in age-related macular degeneration. METHODS: The study comprised 113 referred patients (79 females, 34 males) aged 59-89 years (mean 77.7 years) with predominantly occult CNV. There were 49 cases of occult with no classic CNV and 64 of occult with minimally classic CNV. According to their greatest linear dimension, lesions were classified as being < 3.0 mm or > 3.0 mm. Transpupillary thermotherapy was delivered with a diode laser, emission at 810 nm, duration 60 seconds, laser power 500-800 mW. Clinical examination, ETDRS logMAR visual acuity and fluorescein angiography were carried out at baseline, and at 3, 6 and 12 months in all cases. RESULTS: The average baseline visual acuity was 0.20 (50.6 letters). Following TTT, it was 0.12 (42.0 letters) at 6 months and 0.12 (38.0 letters) at 12 months. Visual acuity improved in 9/113 eyes (8.0%), remained unchanged in 46 (40.7%) eyes, and deteriorated in 58 (51.3%) eyes. There was no significant difference in the proportion of eyes that had lost at least 15 letters at 12 months in the subgroup of occult with no classic CNV (18/49; 36.7%) versus those with minimally classic lesions < 3.0 mm (15/39; 38.5%). However, 13/25 (52.0%) of cases with minimally classic lesions > 3.0 mm had lost at least 15 letters at 12 months (p = 0.31). The most common complications in the 46 eyes that suffered visual loss comprised subretinal progressive fibrosis (18 eyes) and atrophy of the retinal pigment epithelium (13 eyes). CONCLUSIONS: This study shows that TTT generally prevents moderate and severe visual loss at 12 months follow-up in occult CNV with no classic CNV. Eyes with minimally classic lesions with a greatest linear dimension of < 3.0 mm also show the same positive outcome. These results compare favourably with published data on the natural course of the disease. However, minimally classic lesions of > 3.0 mm responded poorly in this treatment setting.

Aged↗
PubMed2000

Indocyanine green enhanced transpupillary thermotherapy of circumscribed choroidal haemangioma.

PURPOSE: To investigate the effect of indocyanine green in enhancing the effect of diode laser for treatment of circumscribed choroidal haemangioma. METHODS: Intravenous indocyanine green was used to enhance uptake of heat energy during transpupillary diode thermotherapy of circumscribed choroidal haemangioma. RESULTS: In a series of 6 patients treated in this manner, response to treatment was much improved compared with results without the use of indocyanine green. All patients retained the same or better visual acuity after treatment, and 67% of eyes improved visual acuity by more than 2 lines on Snellen testing. Ultrasonographic and angiographic evidence of improvement was seen in all patients. Treatment complications were minimal, comprising transient worsening of preexisting cystoid macular oedema in one case, and a small macular branch vein occlusion in the retina overlying the treated area. CONCLUSIONS: The use of indocyanine green as a contrast medium during transpupillary thermotherapy allows consistent uptake of diode laser energy, and shortens the duration of laser burn required. It is a cost-effective, easily performed outpatient procedure, with lower morbidity than other treatment modalities.

Adult↗
PubMed2001

Indocyanine green augmented transpupillary thermotherapy in the management of choroidal metastasis from breast carcinoma.

PURPOSE: To demonstrate the efficacy of indocyanine green augmented transpupillary thermotherapy (TTT) in the management of choroidal metastasis from breast carcinoma. METHODS: A retrospective study was performed on 4 women aged 39-59 years with solitary choroidal metastasis from breast carcinoma in whom choroidal metastasis was managed using mTT. All patients had undergone indocyanine green (ICG) augmented TTT using a diode laser (810 nm) treatment to these lesions and had a mean post-treatment follow-up of 13.2 months. RESULTS: In all the patients there was a gradual regression of the lesion over a mean follow-up of 13.2 months with retention of good visual acuity. CONCLUSION: Indocyanine green augmented transpupillary thermotherapy is a viable alternative for management of solitary choroidal metastasis from breast carcinoma.

Adult↗
PubMed2006

Transpupillary thermotherapy for the treatment of choroidal neovascularization in age-related macular degeneration in Taiwan.

PURPOSE: To evaluate the therapeutic outcome and the recurrence of choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD) after transpupillary thermotherapy (TTT) in light-brown retinas. METHODS: A retrospective, non-randomized study of 58 eyes in 55 patients with subfoveal CNV treated with TTT was conducted. Power settings were set about half the value for Caucasian eyes. The outcome was assessed with best-corrected visual acuity, fluorescein angiography, indocyanine green angiography, and fundoscopic examination. RESULTS: Forty-four membranes were occult, six classic, and eight mixed. Mean follow-up was 16.6+/-10.7 months (range: 6-48 months). Membranes closed in 46 eyes. Iatrogenic complications included three subretinal haemorrhage, two retinal pigment epithelium tears, and two macular area cystic changes. In eyes with occult CNV, visual acuity improved in six (13.6%), 14 (31.8%) remained unchanged, and 24 (54.6%) deteriorated. For various CNV, average logMAR changes from baseline at last follow-up were 0.30 in occult, -0.08 in classic, and 0.59 in mixed (P<0.01). Thirty eyes experienced recurrence within 9.2+/-6.2 months (range: 2-22 months). Cumulative recurrence rate was 45% at 12 months and 71% at 22 months, with no significant difference between occult and non-occult type CNV. CONCLUSIONS: Transpupillary thermotherapy does not cure CNV secondary to AMD. High recurrence was found independent of CNV type. Most improved vision was found mostly in classic CNV. Complications associated with high energy level should be considered in light-brown retinas.

Aged↗
PubMed1998

Pressure-flow studies before and after transurethral microwave thermotherapy of benign prostatic hyperplasia using low- and high-energy protocols.

OBJECTIVE: To compare pressure-flow results before and 3 months after transurethral microwave thermotherapy (TUMT) for benign prostatic hyperplasia (BPH), performed with lower and higher energy protocols. PATIENTS AND METHODS: Twenty-four patients were treated using a high-energy protocol performed with a heatshock strategy, i.e. a rapid increase in intraprostatic temperatures to a maximum of 55-67 degrees C. A helical antenna was used which produced maximum heating at the base of the prostate. A further 25 patients were treated using a lower energy protocol with a slow increase in intraprostatic temperatures to a maximum of 45-53 degrees C. A first-generation filament antenna was used with the maximum heat produced at the prostatic apex. All treatments were performed as single-session outpatient procedures of 60-70 min duration. RESULTS: There was a significantly greater improvement in pressure-flow variables, i.e. maximum urinary flow rate, detrusor pressure at maximum flow and minimal urethral opening pressure, in those treated with higher energy TUMT than in those receiving the lower energy protocol. The Madsen and quality-of-life scores, and maximum urinary flow rate on uroflowmetry, were also significantly better in the higher energy group. CONCLUSION: Higher energy TUMT performed using a heat-shock strategy provides a better pressure-flow outcome than lower energy thermotherapy. Compared with previously published results, the outcome after higher energy TUMT is at least similar to other treatment alternatives for BPH.

Humans↗
PubMed2004

Transpupillary thermotherapy for idiopathic subfoveal choroidal neovascularization.

PURPOSE: To assess the efficacy of transpupillary thermotherapy (TTT) for the management of idiopathic subfoveal choroidal neovascularization (CNV). METHODS: This was a prospective, non-controlled, clinical case trial involving 21 eyes of 21 patients with a mean age of 36 years. All 21 eyes had idiopathic subfoveal CNV and were subjected to diode laser TTT. Laser beam size ranged from 1.2 mm to 3.0 mm and power settings ranged between 300 mW and 600 mW. The end-point was an area of no visible colour change. Pre- and post-laser evaluations of ETDRS visual acuity, contrast sensitivity, slit-lamp biomicroscopy and fluorescein angiography were carried out. RESULTS: The nine predominantly occult and 12 predominantly classic subfoveal membranes were followed-up for a mean of 5.1 months after TTT. Overall, 17 eyes (81%) showed improvement or stabilization in ETDRS visual acuity. Contrast sensitivity improved in 17 eyes (81%). Reading speed improved in 15 eyes (71%). Retreatment was needed in three eyes (14%). CONCLUSION: Transpupillary thermotherapy treatment is a potential strategy for treating idiopathic subfoveal CNV in both its classic and occult forms.

Adult↗
PubMed2000

[Percutaneous interstitial thermotherapy of malignant liver tumors].

PURPOSE: Description of local ablative techniques such as laser-induced thermotherapy (LITT) and radiofrequency ablation in the percutaneous interstitial thermotherapy for malignant liver tumors. PATIENTS AND METHODS: MR-guided LITT is currently performed by means of implantable percutaneous catheter systems. CT is used to control the insertion of the catheter. Irrigated administration systems are available both for LITT and for radiofrequency therapy. RESULTS: At present LITT enables a local tumor control of 97.2% for localized liver metastases without extrahepatic spreading patterns. In a group of 381 patients the average survival times were 45.7 months for patients with liver metastasis, 42.7 months for those with colorectal liver metastases, and 32 months for HCC tumors. The data for radiofrequency ablation confirm the high value for tumor control of hepatocellular carcinomas with poorer results for liver metastases. CONCLUSIONS: Percutaneous, MR-guided LITT permits good tumor control of liver metastases smaller than 5 cm and less than 5 in number. For HCC, at present percutaneous injection of alcohol, radiofrequency ablation, and LITT are equally effective.

Breast Neoplasms↗
PubMed2000

[Laser-induced thermotherapy (LITT) for liver metastasis in an open 0.2T MRI].

OBJECTIVE: To test the feasibility and safety of the laser-induced thermotherapy (LITT) for liver metastases in open MR imaging system operating at 0.2 Tesla. METHOD: Laser therapy using the Nd:YAG laser was performed on 25 patients with a total of 41 liver metastases. An open low-field MRI scanner was used for puncture, positioning of the laser applicator, and monitoring the therapy. A true FISP sequence was used to track the puncture in close to real-time. Localization diagnostics and temperature monitoring were aided by T1-weighted gradient echo sequences in the breath-holding technique. In the first follow up after 24-48 hours, a contrast-enhanced T1-weighted gradient-echo sequence was performed in an MRI scanner at 1.5T. The pre-, intra- and postinterventional volumes of the liver metastases as well as the thermolesions and the thermonecroses were determined. RESULTS: LITT in an open MRI system was technically feasible in all patients with no clinically relevant complications. The mean volumes of the thermolesions measured during intervention in low-field MRI were lower than the volumes of the thermonecroses measured after intervention in high-field MRI. CONCLUSION: The technique presented here of laser-induced thermotherapy for liver metastases in an open MRI system is technically feasible and safe.

Aged↗
PubMed2001

[Laser-induced thermotherapy (LITT). Use of round and pointed laser applicator systems--initial results].

PURPOSE: To assess the advantages and disadvantages by using round and sharp laser application systems during laser-induced thermotherapy. METHOD: 6 in vitro examinations were performed and 12 patients with liver metastases of colorectal carcinoma were treated with laser-induced thermotherapy. All lesions were closely localised to the diaphragm, liver capsule and large intrahepatic vessels. Five patients were treated with the sharp and 7 patients with the round applicator system. After CT-guided insertion of the catheter system into the metastasis laser therapy was performed under MRI control (approx. 25 W, 20 min). RESULTS: Reduction of the distance between the laser applicator and rounded laser catheter tipp (approx. 0.5-1 cm) leads to better placement of the laser applicator in metastases located near the diaphragm, liver capsule and large intrahepatic vessels. Improved therapy results due to complete ablation of metastases were obtained. All patients treated with the round system had complete ablation of metastasis. In 3 of 5 patients treated with the sharp system, MRI control 2 days after therapy showed a residual tumour margin close to the diaphragm or to an intrahepatic vessel. DISCUSSION: Improved ablation can be obtained by closer placement of a round laser catheter in liver metastasis located near the diaphragm, liver capsule and large intrahepatic vessels.

Adult↗
PubMed2005

[Laser-induced thermotherapy (LITT) of tumors of the liver in central location: results and complications].

PURPOSE: To investigate whether laser-induced thermotherapy (LITT) for tumors of the liver in central location is a sufficient and safe therapeutic option. MATERIAL AND METHODS: According to predefined criteria, 23 of 136 patients were chosen to be treated with LITT because of malignant liver tumors. At the time of the first LITT, the patients had 28 central tumors (27 metastases, one HCC), which were treated in 34 sessions with 64 laser applications and had a clinical and imaging follow-up every 3 months. RESULTS: The primary effectiveness rate was 74.1% and the secondary effectiveness rate 82.1%. The mortality rate was 0%. Major complications occurred in one patient (hemorrhagic pleural effusion), while minor complications occurred in 10 patients. During the median follow-up of 20 months (range 3-57 months), local tumor progression developed in 22% of the tumors. The effectiveness rate was 78.6%, 71.4% and 64.3% after 3, 6 and 9 months. The median survival was 46.0 months (95% confidence interval: 28.6-47.1 months). CONCLUSION: In our patients, complications and ablation rate of laser-induced thermotherapy for central liver tumors do not differ from those in peripheral location as described in the literature.

Confidence Intervals↗
PubMed2001

Fluorescein and indocyanine green angiography after transpupillary thermotherapy of choroidal neovascularization. Early vascular changes.

Transpupillary thermotherapy (TTT) is currently being evaluated in clinical trials for the treatment of choroidal neovascularization (CNV). Preliminary results show that TTT achieves closure of CNV and reduction in subretinal exudation while preserving visual acuity. Fluorescein and indocyanine green angiography reveal increased leakage activity from CNV and collateral choroid within 1 hour after TTT and absence of dye leakage from CNV at 1 week after treatment. Optical coherence tomography confirms the angiographic findings. The early vascular changes after TTT of CNV are similar to those observed after PDT of CNV. Transpupillary thermotherapy and PDT might share common mechanisms of action. A placebo-controlled, multi-center trial (TTT4CNV) evaluating the long-term efficacy and visual implications of TTT in occult CNV is underway.

Choroid↗
PubMed2001

Efficacy of transpupillary thermotherapy (TTT) in the treatment of occult subfoveal choroidal neovascularization in age-related macular degeneration.

PURPOSE: To determine the efficacy of transpupillary thermotherapy (TTT) in the treatment of occult subfoveal choroidal neovascularization in patients with age-related macular degeneration (ARMD). METHODS: We conducted a retrospective review of patients with ARMD treated with TTT from June, 1999 through July, 2000 at a retina referral practice. TTT was delivered through a slit-lamp using a modified diode laser at 810 nm wavelength and a spot size of 3 mm delivered at one location for a minimum of 60 seconds duration. Re-treatment was performed at 2-month intervals if indicated. RESULTS: 81 eyes of 77 patients were included in the study. Vision improved greater than one line Snellen in 18 eyes (22%), vision was stable within one line Snellen in 38 (47%), and worsened greater than one line Snellen in 25 (31%). Patients had a mean follow-up of 9 months. The average number of treatments was 1.37 (range 1 to 4). Pretreatment vision was less than or equal to 20/200 in 54% of eyes. CONCLUSIONS: Transpupillary thermotherapy may stabilize visual acuity in a majority of patients with occult subfoveal choroidal neovascularization secondary to ARMD. Proof of therapeutic benefit is best determined by a randomized clinical trial that is currently underway (TTT4CNV).

Aged↗
PubMed1993

Thermotherapy v. antimonials: what happens after the healing of cutaneous leishmaniasis lesions?

The long-term effects of meglumine antimoniate (chemotherapy) or exposure to an environmental temperature of 37 degrees C (thermotherapy) on the evolution of Leishmania mexicana infections and on the response to challenge infections six months after treatment were compared in susceptible (BALB/c) and partially resistant (C57BL/6) mice. Thermotherapy was better than chemotherapy in that it healed lesions quicker and prevented relapses in the partially resistant mice during the observation period. However, both treatments appeared equally effective in terms of clinical cure. Neither treatment cleared all parasites from the hosts and both impaired the hosts' immune response to a challenge infection. The results indicate that specific immunity fades with time post-infection and that the persistence of the parasite in a clinically cured host does not maintain protective immunity against challenge infections.

Animals↗
PubMed2004

Evaluation of three temperature measurement methods used during microwave thermotherapy of prostatic enlargement.

Three temperature measurement methods used during microwave thermotherapy of prostatic enlargement are analysed and evaluated using a phantom model. A commercial transurethral microwave thermotherapy (TUMT) system that uses a radiometric thermometer for temperature control was used to heat the phantom. The transient temperature distribution was obtained by using both fibreoptic (which is considered as gold standard) and thermocouple measurements. Both methods are subject to potential measurement errors caused by electromagnetic and/or thermal interference. The error sources are analysed and the measurement methods evaluated. The radiometric temperature and especially its relation to the transient temperature distribution was evaluated based on the fibreoptic and thermocouple measurements. These measurements in principle gave equivalent temperature distributions, and thermal interference was concluded to be the largest source of measurement error. The radiometric measurement method gave qualitative rather than quantitative readings of the temperature, and an underestimation of more than 10 degrees C was obtained for some parts of the heated area. The area that gives most of the radiometric signal was relatively close to the catheter in contrast to previously published results.

Fiber Optic Technology↗